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IMCA Instruction Criteria — MRCPsych Paper B MCQ

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ModerateMental Health LawIMCA Instruction CriteriaMRCPsych Paper B

In England, an NHS body proposes moving a 79-year-old woman with dementia from hospital to a care home for an expected stay of 10 weeks. She lacks capacity to decide about the accommodation. The decision is not urgent, the placement is not required under the Mental Health Act 1983, and she has no nominated person, attorney, deputy, or appropriate unpaid relative or friend who can be consulted. Under the Mental Capacity Act 2005, what must the NHS body do?

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Correct answer: D — Instruct an IMCA before finalising the accommodation arrangements

The correct answer is D. An NHS body must instruct an IMCA when arranging care-home accommodation expected to last eight weeks or more for a person who lacks capacity for that decision and has no appropriate unpaid person, nominated person, attorney or deputy to consult. Here, the proposed 10-week placement meets that threshold and no urgency or Mental Health Act exclusion applies. A multidisciplinary best-interests process remains necessary but does not replace the statutory IMCA safeguard. A second capacity opinion is not routinely required merely because the person is unrepresented. Court of Protection involvement is reserved for matters such as serious unresolved disputes or decisions requiring judicial authority, not every placement. Deprivation-of-liberty safeguards address a separate legal issue and cannot substitute for an IMCA required for the accommodation decision.

Reference: Department of Health and Social Care, Making decisions: the Independent Mental Capacity Advocate service, sections on changes to accommodation and long-term accommodation moves, updated 26 June 2025. https://www.gov.uk/government/publications/independent-mental-capacity-advocates/making-decisions-the-independent-mental-capacity-advocate-service-web-version